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Kevin Smith included a lengthy list of observations about the Niagara Health System when he released his interim report on the restructuring of the NHS earlier this month.

Smith is the supervisor the provincial government appointed to take over management of the NHS last year — essentially firing the board of directors — shortly after Debbie Sevenpiper was relieved of her duties as the chief executive office.

His report recommends a general acute care hospital and a satellite urgent care centre be built in the southern part of Niagara and that existing facilities in Fort Erie, Port Colborne, Niagara Falls and Port Colborne be closed.

His observations are interesting and are paraphrased here.

1. There is no Niagara. Niagara seems more a collection of various communities that cooperate where absolutely necessary and cooperation occasionally occurs only when every other option fails.

2. A north-south mentality exists. A “Mason-Dixon” line doesn’t appear on any map nor is it clearly defined, but at least related to the NHS, St. Catharines is “north” and the other communties are “south”.

3. Lack of community confidence in the NHS. The degree of lack of trust, confidence and support was at an extreme level when a report on trust and reputation was prepared in November 2011.

4. Poor morale at all levels of the organization. Morale is a major concern. Concerns expressed by staff include a perception of punishment for speaking out, favouritism in promotions and overall poor communications and recognition of contributions.

5. Complex decision making process. Although told that the NHS is too big and complex and needed to be broken up, Smith disagrees. The decision making process is not universally understood nor consistently applied across the organization.

6. Lack of accountability. All staff and physicians from the frontline to the executive team need to have clear guidelines and standards of accountability and be held responsible.

7. Little reinforcement of code of conduct and culture of mutual respect. All employees and physicians from frontline to executives should be required to follow the same rules with respect to their interactions with colleagues and be held accountable if they don’t meet accepted standards of behaviour.

8. Lack of openness to learning from outside organizations. Until recently, the NHS has isolated itself in terms of learning from other organizations and adopting and sharing best practices with others.

9. Support for development of academic health care. The NHS has a unique opportunity to develop a first class academic environment for learners in partnership with McMaster University, Brock University and Niagara College which could have direct positive impact on quality of care and employee recruitment and retention.

10. Lack of recognition and celebration of advances. There is little acknowledgement of the work done to bring state-of-the-art programs in cancer care, cardiac care and mental health to the people of Niagara.

11. Lack of standardization.Examples range from lack of consistent housekeeping to inconsistent adoption of best practices in clinical care delivery between departments and from site to site. It is costly and confusing for staff, physicians and patients.

12. Location of St. Catharines site. “We need to move on, recognize that it can’t be moved and celebrate the tremendous improvements in clinical care for all the citizens of Niagara that will result. The location of the new South site is more important than ever and it should be designed to complement the new facility in St. Catharines.”